National lockdown -for pity’s sake use it to get ‘test and trace’ working – Dr John Puntis

National lockdown

On the 31st October 2020, the prime minster announced that England would once again come under a national lockdown for coronavirus five and half weeks after this was first recommended by the government’s own Special Advisory Group for Emergencies (SAGE). Over that period of dithering, daily new cases of Covid-19 infection increased from 4,964 to 21,915, hospital in patient cases from 1,502 to 10,000 and deaths from 28 to 326. Scientists, campaigners and many members of the public expressed anger and amazement at the slow response by ministers and their delay in taking decisive action. Exclusion of schools from the lockdown is now causing concern to both parents and teachers, with the National Education Union (NEU) alarmed by evidence of surging infection among pupils calling for them to be closed.

Fatal slowness – lessons not learned

On the 30th January 2020, having considered the situation in China, the World Health Organisation declared Covid-19 a Public Health Emergency of International Concern. Such a declaration equates to an assessment of a situation as ‘serious, unusual, or unexpected; carries implications for public health beyond the affected State’s border; and may require immediate international action’. The following day, a team of scientists at the University of Hong Kong recommended that ‘draconian measures that limit population mobility should be seriously and immediately considered, as should strategies to drastically reduce within-population contact rates through cancellation of mass gatherings, school closures, and instituting working from home . . . .preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies, and the necessary human resources . . ‘. The same day, the first cases of Covid-19 were identified in the UK. We must not forget that the Westminster government then chose not to heed these warnings, consistently underestimated the risks involved and dragged its feet in making important decisions. This has lead to the UK having the highest death toll in Europe, and provides an urgent and compelling basis to call for an immediate inquiry into the handling of the pandemic so that lessons can be learned and put to use.

No convincing exit strategy

There is no end to the pandemic in sight. A vaccine might become available and might be effective, but only time will tell. Some Conservative politicians
such as John Redwood have become medical experts, feeling able to advise the ‘Today’ programme on BBC Radio 4 that new treatments had changed the outlook for patients. He is, however, appropriately more guarded on his website,
mentioning only the role of steroids and requesting information from ministers on other drug trials. Steroid treatment in critically ill patients on a breathing machine has been shown to decrease the risk of death by a third, but this is small comfort if the number of very sick patients requiring intensive care exceeds the number of beds available. Trials of other drugs have been disappointing so far, with a number of agents including the much touted Remdesevir showing no effect on improving survival. NHS England claim overall improvements in management of patients has produced a modest increase in survival for those needing life support, from 72% to 85%.

Serco and the failed privatised ‘test and trace’

Astonishingly, Redwood makes no criticism of the disastrous and privatised national ‘test and trace’ system, which recently had it worst week ever, reaching only just over 60% of its target 80% of contacts. Of course, all contacts reached should also self isolate, but in reality only around 1 in 5 do so because ‘support’ is not integral to the ‘test and trace’ strategy, as it should be. Serco’s hopeless management of the whole system continues to beggar belief, and now includes the fact that untrained 18 year olds were magically transformed from level 3 call handlers to level 2 clinical contact caseworkers – a position previously reserved largely for qualified doctors. The predictable consequences were described as “a shit show” by one of the distressed employees. Serco claimed it was acting on instructions from the Department of Health and Social Care, which confirmed this was indeed the case.

For Redwood to acknowledge the incompetence of Serco would be an admission that contracting out to a private sector provider is not in fact a guarantee of success, something conservative ideologues find impossible to concede. How much further evidence is required to open the eyes of those who will not see? Most recently, the contract for operation and development of the UK’s nuclear weapons is being taken back into public management after criticism by the National Audit Office of the hundreds of million of pounds being wasted, one of the companies involved being Serco!

Close the schools – support the NEU

School is vitally important for children and loss of educational opportunities may have devastating long term consequences in terms of life chances. Conversely, there are risks of increased community viral transmission when schools are open. Risk reduction and an increase in distance learning should be part of the ongoing Covid-19 management plan. School reopening after the first lockdown was not supposed to happen until the number of new Covid-19 cases had been driven down to a very low level, and an efficient ‘test and trace’ system was in place. Both of these commitments were abandoned by a government obsessed with playing down Covid’s threat to our health while constantly highlighting its potential to cause economic harm. Sadly, the government’s commitment to children’s education and the ‘levelling up’ agenda can be gauged by the fact it has recently slashed funding allocation for laptops to disadvantaged families by 80%
as well as its refusal to continue to provide free school meals during the holidays for children from low income families.

Managing risk in schools

Preconditions that should have been observed for schools to re-open were set out by Independent SAGE: drive community transmission down to low levels; wear masks in secondary schools; additional teachers and spaces and smaller class sizes so that social distancing is feasible; monitoring of ventilation (given aerosol spread in classrooms); provide resources necessary for study at home; clear guidance regarding when to get tested and what to do about isolation; local testing with rapid turnaround of results. We now have a situation where in one week over half a million people were infected, with the highest rates in teenagers and young adults and the most steep rise in school children. The overriding risk factors for spreading infection are known to be closed spaces with poor ventilation, mingling in crowds and settings where there is close contact (a good description of schools!). To be serious about driving down infection once again, schools must be closed and only re-opened when the above preconditions have been met; an urgent task for the Department for Education.

Back to basics – we must have a public test, trace and support system

With cooperation from the public, a second national lockdown is likely to be effective in driving down numbers of cases once again, however, there is no point going back to the previous situation and repeating the exponential increase in cases that followed the ending of the first lockdown. Together with increased surveillance at borders and quarantine for travellers, an effective ‘find, test, trace, isolate and support’ system as outlined by Independent SAGE is the only thing that is likely to make a major difference. This should also incorporate ‘backward’ contact tracing (not being done in the UK at present) where the origin of infection is sought in order to find those super-spreaders – the 10% of people who cause 80% of infections.

The fact that the current privatised system will not and cannot work effectively has not yet been recognised by the government despite all the evidence. Until this issue is grasped and an effective local public health system put in place, we are doomed to repeat cycles of rising infection followed by lockdown with disastrous consequences for both health and the economy. Just as the provision of clean drinking water and sewerage in the 19th century was ushered in only when hundreds of thousands of cholera deaths spread from poor to rich communities, perhaps it is only a grotesquely rising death toll that will prompt decisive action? In the light of what we already know, this would not only represent more criminal foot dragging, but further highlight the callous disregard of this government for its people and their wellbeing.

John Puntis

2nd November, 2020

Supply of Medicines post #Brexit

SUPPLY OF MEDICINES FOLLOWING A NO-DEAL BREXIT

SITUATION AT 12 SEPTEMBER 2020

NOTES BY LEEDS HOSPITAL ALERT

Sources of information:

Cabinet paper: “Operation Yellowhammer: Government’s Worst Case Planning Assumptions” (11 September 2019).
Statements from the British Medical Association and the Healthcare Regulatory Authority.
Statement by Meg Hillier MP, Chair of Public Accounts Committee.
Audit Office report: “Exiting the EU: Supplying the Health and Social Care Sectors” (27 September 2019).
British Medical Journal articles dated 14 November 2018 and 20 August 2019.
Letter from Michael Gove, Chancellor of the Duchy of Lancaster, to Stuart Andrew MP, dated 3 October 2019, in response to his letter about supplies of medicines, dated 18 June 2019.

In addition: Leeds Hospital Alert was advised by Leeds’s Director of Public Health to send questions about the supply of medicines following a No Deal Brexit to the Ministerial Correspondence and Public Enquiries Unit at the Department of Health, and wrote on 20 February 2020. The Unit replied on 30 March to say that it could not answer the enquiry. A follow-up call to the Unit on 11 September revealed that the Unit “has no specific information” about the supply of medicines.

The Basic Problem and the Government’s Proposals

Three quarters of medicines used in the UK come from the European Union, mainly by the “Short Straits” route to Dover and Folkestone. After Brexit, access will be reduced to 40% – 60% of current supplies for up to six months.

The government proposes to deal with this in three ways:

Stockpiling: The government told medical suppliers in August to stockpile six weeks’ worth of medicines as a “buffer” against disruption when the Brexit transition period ends on 31 December.

New freight routes: the government has finalised a contract (£87m) with four ferry groups to bring in medicines on seven other routes rather than on the “Short Straits” route. There will also be aircraft chartered to bring in medicines with a short life, and a dedicated courier service.

Changes to Regulatory Requirements: using the government’s existing “Serious Shortage Protocols”, pharmacists will be able to provide alternative medicines of the same quality and pharmaceutical content, with different strengths up to the same dose; the therapeutic equivalent of any medicines not available.

Questions to the Government

Why is the proposed period for stockpiles planned for six weeks, when disruption of supplies is forecast to last six months?

The British Medical Association and the Royal College of Nursing have pointed out that “many medicines cannot be stockpiled”. What are the government’s plans for these medicines?

How will stockpiling work for medicines that need to be kept at a controlled, low temperature during transport and storage? These medicines include insulin and medicines derived from blood plasma. Sir Michael Rawlins, Chair of the Medicines and Healthcare Regulatory Authority, has expressed particular concern about the storage of insulin in stockpiling.

The Audit Office reported that ministers do not know if there will be enough freight capacity in place to cope. Will the government issue new information confirming that the capacity exists?

How will the new freight routes work? Which companies will be running them? How will medicines such as insulin be transported safely? What professional oversight will there be of the process?

When will the government issue information to patients and their families who are worried about the supply of medicines? Attempts to get information directly have not proved successful (e.g. correspondence with the Department of Health, quoted above). Diabetes UK states: “We are concerned that the government has not communicated its plans regarding the continued supply of insulin in the event of a no deal Brexit, which is causing unnecessary concern for people with diabetes”.

Matt Hancock, Secretary of State, has apparently refused to rule out that people could die because of shortages of medical supplies following a No Deal Brexit (Evening Standard, 15 November 2018). Does Mr Hancock still stand by this statement?

Brexit medicines

12092020

Yorkshire Health Campaigns Together meeting 1st May 2020

Yorks HCT mtg 1.5.20 final

Summary Action Agreed

  1. Push the “Test, test, test, PPE, Keep Key Workers Virus free” message. Gilda can send A4 rainbow poster on request and will pass on a new one 999 is preparing
  2. Consider taking the clap out from our streets to more public places such as outside hospitals, maybe even Social Care homes.
  3. Spread campaign re migrant charging (Leeds open letter attached)
  4. Press local and regional health and Social Care Scrutiny Boards to meet (Jenny writing)
  5. Start some serious campaigning for a national, free at the point of use, public national Social care service.
  6. Don’t lose sight of Trade deals and exert what pressure we can on our MPs et al
  7. Do all we can to support whistle-blowers
  8. Think creatively about co-ordinated celebration, protest, campaigning and maybe even marching in July. Possibly on the weekend of 4th and 5th and maybe 25th as well.

Nationalising Special Purpose Vehicles to end PFI: a discussion of the costs and benefits by Helen Mercer and Dexter Whitfield:

MERCER_Nationalising_Special_Purpose_Vehicles_to_End_PFI_2019

Important public meeting online, May 5th 7pm, Coronavirus crisis: What now for the NHS?

Speakers:

Richard Horton – Editor of The Lancet
Professor Allyson Pollock – Consultant in public health and director of Newcastle University Centre for Excellence in Regulatory Science
Dr John Lister – editor of Health Campaigns Together, co-editor of The Lowdown (Lowdownnhs.info)
Dr Sonia Adesara – Junior Doctor and member of KONP’s NHS Staff Voices group
Pam Kleinot – Producer of Under The Knife

This is an online meeting held via Zoom, an easy-to-use videoconferencing app.

Please register here: https://us02web.zoom.us/webinar/register/WN_SeVsKXHHRIa2fvHiDRZVJg

Join Keep Our NHS Public and Health Campaigns Together, to hear from expert analysts, frontline NHS workers and the producer of Under The Knife (feature documentary on the  covert dismantling of the NHS) to hear about how, aggravated by Government arrogance and failure in the early stage of the Coronavirus outbreak, the NHS has been defunded, understaffed and fragmented by privatisation to such an extent that it’s preparedness for the current emergency has been severely undermined and has needlessly cost lives.

Dr John Puntis in The Independent

https://www.independent.co.uk/voices/boris-johnson-coronavirus-uk-nhs-eu-symptoms-a9372526.html

As a doctor, I’m telling Boris Johnson – a Little Britain response to coronavirus will be deadly

We have long known that pandemics do not respect borders. If Johnson removes us from the EU’s disease response network, the consequences could be disastrous

In 1831, the first “Asiatic cholera” pandemic reached the UK via the port of Sunderland. Although the terrible nature of the disease was evident to local doctors, vested interests delayed the notification of authorities in London because of concern about negative effects on business. Of course, more people died, and the port was quarantined.

This cholera pandemic was probably the first time the international dimensions of managing a public health emergency became clear. With 90,000 coronavirus infections and 3,000 deaths worldwide, there is now a new spectre haunting the globe.

The Organisation for Economic Cooperation and Development warns that coronavirus could slash global economic growth rates in half, as factories shut down and supply chains are broken apart. Meanwhile, the European Union has raised the risk of infection from moderate to high.

The UK appears woefully unprepared for coronavirus. The NHS is already in bad shape, with the worst ever A&E waiting times, over 95% bed occupancy, 100,000 staff vacancies and the prospect that a no-deal Brexit will majorly disrupt the supply of medicines. With the worst-case scenario suggesting up to 50 million infections and up to 250,000 deaths in the UK alone, there can be little doubt that both health and social care services will be severely challenged by even a modest intensification of the outbreak.

More worryingly still, it appears the UK government is allowing petty infighting to hamper its preparations for a pandemic. It is staggering to hear that, as the virus continues its rapid spread, Downing Street and the Department of Health and Social Care (DHSC) are locked in a row about Brexit – specifically, the UK’s continued access to the EU Early Warning and Response System (EWRS) for communicable diseases. The DHSC, it is reported, wish to remain in the EWRS, the prime minister decidedly does not.

The EWRS was created by the European Commission to “ensure a rapid and effective response by the EU to events (including emergencies) related to communicable diseases.” In the web-based system – which links the European Commission, public health authorities and the European Centre for Disease Prevention and Control – appointed contacts in member states receive real-time notifications of emerging communicable disease threats, and proposed measures to control them. This allows prompt and coordinated action to fight outbreaks of infectious disease.

A number of organisations have attempted to steer the government away from the disastrous course of leaving the EWRS. The Brexit Health Alliance (BHA), for example, brings medical researchers, patient groups and public health bodies to safeguard the health service during Brexit negotiations. It argues that it is in both Europe and the UK’s interests to cooperate in handling public health issues, and BHA lists the EWRS is as an important mechanism for doing so – not that the government seems to care.

The Faculty of Public Health (FPH) is another expert body whose advice is being ignored. The FPH praised then health secretary Jeremy Hunt for acknowledging that public health emergencies transcend global boundaries, and for committing to making health security central to our Brexit negotiating position. These are commitments over which the government is now riding roughshod, and for what appear to be political reasons.

Under Johnson, Britain appears to be adopting similar isolationism in its public health policy as in its foreign policy. Yet we have known since at least 1831 that pandemics do not respect borders. A “Little Britain” approach to coronavirus is not merely unwise – it is dangerous. Fighting Covid-19 requires us to work with our European neighbours – if we do not, we are putting lives at risk.

The government’s plans to fight coronavirus include recruiting retired doctors like me. Yet domestic skills can be no substitute for international collaboration. As a former consultant paediatrician, I am asking Number 10: for patients’ sake, do not take us out of the EWRS.

Dr John Puntis is co-chair of Keep Our NHS Publlic

Letter for Parliamentary candidates – please use and share

Dear General Election Candidate,

HEALTH CARE: WHAT A BREXIT DEAL MUST INCLUDE

The British Medical Association has published a Briefing on what a Brexit deal must include to safeguard health care for people in the UK.

The Briefing calls for the following safeguards for patients and the NHS in any Brexit deal. Please let me know how once you are elected you will ensure that the government will implement each of these safeguards:

A Brexit deal must include:

Free movement for healthcare and medical research staff

Permanent residence for EU doctors and medical researchers currently in the UK

Continued rights for EEA medical students in the UK to live, train and work in UK health services

Continuation of the existing open border arrangements between Northern Ireland and the Republic of Ireland

Ongoing cross-border co-operation in the delivery of healthcare to patients on both sides of the border between Northern Ireland and the Republic of Ireland

Freedom of movement for healthcare workers to live and work on both sides of the border between Northern Ireland and the Republic of Ireland

Ongoing MRPQ (Mutual Recognition of Professional Qualifications) to provide doctors the means to move and work between both Irish jurisdictions

Ongoing participation by the Medicines and Healthcare Products Regulatory Agency in the regulatory framework for pan-European clinical trials

A formal agreement between the UK and European Medicines Agency to continue to support and participate in their assessments for medicine approvals

Mutual recognition of, and ongoing participation in, the CE scheme for medical devices

The retention, or comparable replacement, of reciprocal health care arrangements and access to healthcare for both UK and EU citizens

The maintenance of reciprocal arrangements, such as the MRPQ (Mutual Recognition of Professional Qualifications), to facilitate the ongoing exchange of medical expertise across Europe and ensure quick access to the UK healthcare system be appropriately trained EU doctors

Ongoing access to the IMI (Internal Market Information) alert system, which enables regulators across Europe to send and receive alerts about doctors’ fitness to practise across the EU

The retention of measures to protect public health standards, including those affecting food, alcohol, air quality, and tobacco regulations

An agreement between the UK and the EU to continue to share data and emergency preparedness planning in relation to cross-border threats

Ongoing access to EU research programmes and research funding

Immediate certainty for UK researchers who currently access Horizon 2020 funding about funding and collaboration on existing and future research projects

Continued access to the European Investment Bank to fund research programmes

Ongoing access to and participation in the European Reference Networks, enabling healthcare providers across Europe to tackle complex or rare medical conditions requiring highly specialised treatment

Abolition of the charge to migrants from outside the EEA to use the NHS.

I look forward to your reply.

Kind regards,

Yours sincerely,